Prognostication and Prediction of Outcomes in Patients with Organophosphorus and Carbamate Poisoning: A Prospective
Avanish Jha1, Darpanarayan Hazra2, Bijesh Yadav3
1Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
Summary
A rapid bedside test for cholinesterase activity (ChE check mobile) effectively aids in diagnosing and managing organophosphorus (OP) and carbamate poisoning. Low red blood cell cholinesterase (E-AChE) levels correlate with higher atropine doses and poisoning severity.
Area of Science:
- Toxicology
- Clinical Diagnostics
- Emergency Medicine
Background:
- Organophosphorus (OP) and carbamate poisoning pose significant health risks, particularly in developing countries.
- Accurate and rapid diagnosis is crucial for effective patient management.
- The ChE check mobile is a novel bedside diagnostic tool for cholinesterase activity.
Purpose of the Study:
- To evaluate the effectiveness of the ChE check mobile diagnostic test.
- To assess the correlation between cholinesterase levels and poisoning severity.
- To determine the utility of the test in managing OP and carbamate poisoning.
Main Methods:
- Prospective observational study over one year involving 60 patients with OP or carbamate poisoning.
- Systematic measurement of red blood cell cholinesterase (E-AChE) and butyl cholinesterase (BChE) levels.
- Analysis of atropine dosage and correlation with E-AChE levels.
Main Results:
- A significant negative correlation was observed between E-AChE levels and both initial and total atropine doses.
- An E-AChE cut-off of 4 units/g hemoglobin showed 80.0% sensitivity and 68.6% specificity for predicting moderate to severe poisoning.
- Monocrotophos and carbofuran were the most common causative agents.
Conclusions:
- The ChE check mobile is a valuable tool for prognostication in OP and carbamate poisoning.
- Low E-AChE levels are significantly correlated with increased atropine requirements and poisoning severity.
- The diagnostic test aids in predicting patient outcomes.
Keywords:
AcetylcholinesteraseCarbamate poisoningChE check mobileOrganophosphorus poisoningPseudocholinesteraseRBC cholinesteraseMore Related Videos
Related Concept Videos
01:26Anticholinesterase Agents: Poisoning and Treatment
859
Anticholinesterases, also known as cholinesterase inhibitors, work by blocking the breakdown of acetylcholine, leading to its accumulation in the synaptic cleft. This accumulation indirectly enhances both muscarinic and nicotinic actions. These agents are classified as reversible or irreversible based on their mechanism of action.
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is...
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is...
859
01:14Prevention of Further Absorption of Poison
823
In cases of acute poisoning, the primary objective is to prevent further absorption of the toxic substance into the body. Immediate interventions using various decontamination techniques targeting the gastrointestinal (GI) tract can achieve this. Decontamination is crucial to prevent poison from entering the systemic circulation, which involves washing affected areas with water and mild soap and removing contaminated clothing. Once external decontamination is done, attention must be turned to...
823
01:22Indirect-Acting Cholinergic Agonists: Pharmacokinetics
982
Indirect-acting cholinergic agonists, or anticholinesterases, enhance the body's cholinergic activity by inhibiting acetylcholine's breakdown. They are categorized as reversible or irreversible agents based on their mechanism of action. They are further classified into short-acting, intermediate-acting, and long-acting agents based on their duration of action.
Reversible agents containing quaternary amines, such as neostigmine and edrophonium, are not easily absorbed orally because they...
Reversible agents containing quaternary amines, such as neostigmine and edrophonium, are not easily absorbed orally because they...
982
01:18Indirect-Acting Cholinergic Agonists: Mechanism of Action
1.8K
Indirect-acting cholinergic agonists work by interacting with an enzyme called acetylcholinesterase (AChE) in the synaptic cleft. They can be reversible or irreversible inhibitors and have different effects on the enzyme.
Reversible inhibitors like edrophonium bind to a specific part of the enzyme called the anionic catalytic site. They form noncovalent bonds, which means they are not strongly attached to the enzyme. This creates a temporary and less stable enzyme–inhibitor complex,...
Reversible inhibitors like edrophonium bind to a specific part of the enzyme called the anionic catalytic site. They form noncovalent bonds, which means they are not strongly attached to the enzyme. This creates a temporary and less stable enzyme–inhibitor complex,...
1.8K
01:36Types of Toxins
1.7K
Humans continually engage with an environment rich in potentially harmful chemicals. These are introduced to our bodies through inhalation, ingestion, or skin contact. These chemicals exist in various forms, such as air and environmental pollutants, agricultural chemicals, organic solvents, and heavy metals.
Air pollutants, primarily gases, pose significant threats to respiratory health, leading to conditions like hypoxia, lung cancer, and in extreme cases, death.
Environmental pollutants like...
Air pollutants, primarily gases, pose significant threats to respiratory health, leading to conditions like hypoxia, lung cancer, and in extreme cases, death.
Environmental pollutants like...
1.7K
01:19Depolarizing Blockers: Pharmocokinetics
327
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
327